RCGP warns of 'mass exodus' if retention of GPs isn't prioritised

Over 40% (42%) of GPs are unlikely to be working in general practice in five years' time - with a quarter saying it is very unlikely - according to shock polling from the Royal College of GPs, made public today.

The picture is most stark in England, with the highest rate of GPs considering leaving being found in the East of England and the South East (47%) and the lowest in the North West (36%).

More than half (51%) of GP respondents said finding the job too stressful (51%) is a key reason for considering leaving, ahead of retirement (38%). 13% of respondents plan to leave the UK.

Last week's review of the NHS in England by Lord Darzi made clear that GPs and their teams are increasingly doing more work, but for a decreasing share of the NHS budget. In the past year, GPs and their teams have delivered an average of 30 million appointments per month – over 4 million more each month than in 2019 – while the number of fully-qualified, full-time equivalent GPs has fallen by 601 over the same period.

The pressures GPs are reporting are so intense that 22% of GPs feel so stressed they can't cope, around once or twice a week. As well as highlighting the number of GPs considering leaving the profession earlier than planned, the College's survey found 1 in ten respondents expect their practice will be forced to close or hand back its contract within the year.

The RCGP survey found nearly 8 in 10 GPs (79%) are worried about the impact that having fewer GPs in the profession will have on the patient care they can deliver.

More than 2,000 GPs took part in the survey. Of these:

• Almost 4 out of 10 GPs said they regularly worked more than 40 hours a week despite fewer than 1 in 10 being contracted to do so.
• Over three-quarters of GPs (77%) said that patient safety is being compromised by their excessive workloads.
• Six in ten (60%) GPs reported that they didn’t have enough time to adequately assess and treat patients during appointments.
• 62% felt they didn’t have enough time during appointments to build the relationships with patients they need to deliver quality care. 
• 71% of GPs believed that their practices could alleviate pressure from hospitals if they had more staff and resourcing.

When asked what would be likely to help keep them in the profession, 66% of respondents who are considering leaving the profession cited a reduction in administrative workload, with 56% saying a reduction in clinical workload. 

More than a quarter said access to a formal retention scheme would help - and of those who had already received support or funding for a retention or returner scheme, 60% reported it made them more likely to continue working as a GP.

Despite this, over the last year two schemes - the New to Practice Fellowship and Supporting Mentors schemes - both of which had the potential to keep GPs in the profession have been closed to new applicants nationally or placed under review. Local NHS bodies (ICBs) have been told to pick up the challenge of GP retention, but there is no ringfenced money for this. National schemes and local retention schemes in parts of the country do exist, but the College's polling shows only small numbers of GPs have been engaged with them.

Almost 10,000 RCGP members responded to the College’s call to write to Health Secretary Wes Streeting shortly after his appointment, asking for a review of NHS England's Long Term Workforce Plan (LTWP) to give it more focus on retention, as well as recruitment. 

The LTWP as it stands only aims to increase the number of fully qualified GPs by 4% by 2037, compared to a 49% growth in hospital consultants, according to National Audit Office analysis. In the letter, Professor Kamila Hawthorne, RCGP Chair said: "We need a comprehensive plan to provide sufficient capacity to train more GPs, do much more to retain the GPs we have, and ensure GP practices have the infrastructure and resources to employ enough GPs and their teams to deliver safe, timely and appropriate care to our patients."

Commenting on the polling results, Professor Hawthorne, said: "The new Government has made very clear its intention to shift more resources into the community - and the necessity for this came through loud and clear in Lord Darzi's recent report.

"This makes absolute sense. General practice is the bedrock of the NHS - GPs and our teams make the vast majority of NHS patient contacts, for a relatively small percentage of the overall budget. In doing so, we deliver care close to home where patients want it, and we alleviate pressures in secondary care, including in A&E, where it is more expensive.

"But our service is struggling - our workforce is struggling, as our polling demonstrates all too bluntly. Workload in general practice has escalated, both in terms of volume and complexity, yet we have fewer qualified full-time equivalent GPs than we did five years ago. We can’t afford this mass exodus of qualified GPs because of the stress of the job leading to them burning out, we can’t afford to have practices closing because the pressures are so intense. This can't continue.

“Whilst we didn’t ask GPs what they would do if they left the profession for reasons other than retirement, 13% did say they were planning to leave the UK and work overseas where they might be offered roles which promise a better work-life balance. In some cases, we know that GPs may move abroad temporarily and return to the UK in a couple of years – but if people are considering leaving long-term, that’s a real loss to the NHS.

“Anecdotally, we’ve also heard reports of GPs planning to leave, or at least take a break, from medicine altogether – others may leave the NHS but choose to work privately, and others may leave salaried or partner roles and become locums, which can offer more flexibility. Whatever the reason, it just goes to show how important it is that we have robust retention schemes in place that may make them reconsider.

"We agree with the Secretary of State's aspirations, but we will need enough of the right people in the right places in our health system to achieve these. It's encouraging to see more medical students choosing general practice year on year - although we still need more - but we must also see considerable efforts going into keeping our highly-trained, hard-working GPs in the profession longer, seeing patients on the frontline and providing safe, high-quality care.

"The current situation is dire, but with the right investment and realistic initiatives to recruit and retain more GPs, we can turn things around.  GPs are highly trained to deliver the safe, timely and appropriate care our patients need. They want to do the best that they possibly can for their patients, now and in the future, and they deserve to be given the support and resources they need to do their jobs, without jeopardising their own health.”

Further information

Research by Design was commissioned by RCGP to deliver this survey. The survey was in field between 13th May 2024 and 10th June 2024, and it received a total of 2,190 complete responses from across the UK. 

RCGP press office: 0203 188 7659
press@rcgp.org.uk

Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.